MEDICARE: DR. JEFFREY THEODORE VANGELDEREN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	4301405970	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043217979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY THEODORE VANGELDEREN M.D.

Provider Business Mailing Address
First Line	:	248 WASHINGTON AVE
Second Line	:	SUITE A
City	:	BAY CITY
State	:	MI
Zip	:	48708-5848
Country	:	US
Telephone Number	:	989-892-5664
Fax Number	:	989-892-0662

Provider Business Practice Location Address
First Line	:	248 WASHINGTON AVE
Second Line	:	SUITE A
City	:	BAY CITY
State	:	MI
Zip	:	48708-5848
Country	:	US
Telephone Number	:	989-892-5664
Fax Number	:	989-892-0662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/19/2023

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